Multicultural Perspectives on Psychotherapy

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Multicultural Perspectiveson Psychotherapy
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Where did we leave off?

• Clinical Implications
• Should we focus on race, class, and culture in
  therapy?
• The two good arguments NOT to
• 1. We are all fundamentally the same.
• 2. Each of us is a unique person with unique
  life experiences.

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• Researchers and practitioners who advocate for
  the opposite stance that focusing on class,
  race, and culture is necessary cite a broad
  range of reasons to support their claims.
• So lets consider some of them

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What do we mean by culture?

• Culture is the traditions, beliefs, and values
  which are present in and passed down among
  members of a certain group.
• Sources of culture can include
• - race
• - ethnicity
• - sexual orientation
• - gender

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Issue 1 Accurate Assessment Diagnosis

• The DSM IV
• - Uses discrete categories to classify disorders
  according to the presence of certain symptoms.
• ? Does our classification system work across
  cultural groups?
• - Research/clinical observation used to
  produce the
• categories come from populations that were
• predominantly White.
• - Some critics will argue that the
  categories of the DSM are
• not directly useful for diagnosing
  individuals of different
• cultural backgrounds.

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Issue 1 Accurate Assessment Diagnosis

• The DSM acknowledges the existence of
  culture-bound syndromes
• - The culture-bound disorders mentioned by the
  DSM are relegated to an appendix, and relatively
  little consideration is given to cultural
  differences throughout the rest of the book.
• - This implies that the disorders in the regular
  sections of the DSM are universal (i.e. not
  culture-bound).

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Issue 1 Accurate Assessment Diagnosis

• The same disorder, different presenting problems
• - What if the disorder really is the same, but
  it doesnt look the
• same because of culture?
• ? Culture may influence manifestations of
  disorders.
• - Depression
• ? Dhat
• ? Hwa-byung
• - PTSD in Southeast Asians

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Issue 1 Accurate Assessment Diagnosis

• Completely different disorders
• - It is possible that the disorders we see in
  the U.S. are only
• found in the U.S. because of our social norms
  and
• experiences, which are specific to the
  American culture.
• - Major Depressive Disorder prevalence rates.
• - Culture may influence what disorders we have
  altogether.
• - The disorders mentioned previously may really
  be
• different.
• - On the other hand, how can we know? We might
  be
• misdiagnosing or failing to recognize the
  disorders.

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Issue 2 Appropriate Training

• APA accreditation
• - APA requires its graduate programs to
  recognize the importance of diversity in the
  training and education they provide to their
  students.
• ? UIUC, for example
• Coursework and Practica
• - As students, we want to receive training and
  education in the most effective therapeutic
  techniques and approaches.

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Issue 3 Treatment Research Applicability

• RCTs and ESTs
• - RCTs tend to be performed on homogeneous
  populations mostly White, middle class
  populations.
• - Yet, the population of ethnic minorities (for
  example) in the U.S. is approximately 30, and it
  is expected to increase over the next few
  decades.
• - We have no evidence that our current
  treatments work specifically with these
  populations.

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Issue 3 Treatment Research Applicability

• It is important to note that this is not
  necessarily because
• researchers are purposefully excluding
  members of other races or ethnicities. But, for
  some reason, these populations are
  underrepresented in these studies.
• ? What does this mean for the generalizability
  of the
• findings of RCTs? How does that limit the
  treatments we
• consider to be ESTs?
• - We do know that these individuals underutilize
  services and drop out of therapy earlier in the
  process.

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Issue 4 Therapist Characteristics

• The majority of clinicians are White. They grew
  up in the U.S. And they are obviously
  well-educated and likely to be middle-class.
• - Many proponents of multiculturalism in
  psychotherapy will advocate for ethnic
  matching.
• ? Does ethnic matching improve psychotherapy
• outcomes?
• ? What if ethnic matching is not possible?

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Alright, so I just gave youa bunch of
problemsNow, what do we do to fix them?
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Cultural Competency

• What is Cultural Competency?
• Its not easily defined, but what might it
  entail? What might it NOT entail?

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Considerations about the Therapist

• Be aware of your attitudes regarding culture.
• - S/he needs to consider the role that culture
  plays in his/her own
• life.
• - Consider how s/he perceives culture as an
  influence on
• individuals and society.
• - Be aware of a tendency to advocate for
  assimilation into
• American culture or maintenance of traditional
  cultural beliefs
• and practices.
• Never make assumptions.
• - Dont assume that a persons cultural
  background tells you
• anything important.

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Considerations about the Therapist

• Be cognizant of cultural explanations of
  phenomena.
• - The behaviors displayed may not be considered
  maladaptive
• or abnormal in the other culture.
• - there may be a cultural explanation for the
  clients
• experiences.
• Beware of oversimplified cultural explanations.
• - For example, the idea of collectivism vs.
  individualism is a broad dichotomy. In reality,
  these differences probably lie on a
  continuumwith not only variation between
  cultural groups but also within cultural groups.

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Considerations about the Therapist

• Issues of Cultural Relativism
• - There may be times when the clients culture
  seriously clashes with the values/beliefs of the
  therapist.
• - It is difficult to know what to do in these
  situations.
• ? Fowers Richardson (1996) assert that the
  therapist can choose to reject the questionable
  behaviors of the other culture. However, this
  is contingent upon the therapist first having an
  accurate and complete perspective on the
  clients culture.
• How might we accomplish this?

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Considerations about the Client

• Traditional culture may only be a part of the
  clients identity
• - A persons identity is complex, and cannot be
  summed up
• simply by considering their culture of origin.
• - The individual may or may not be very
  connected with the
• traditions, beliefs, and values of the other
  culture.
• Acculturation the process of psychosocial
  change generated
• when a group or an individual comes into
  continuous first-hand contact w/ another
  culture and is, thus, affected by both adherence
  to traditional culture and exposure to a new
  culture (Karlsson, 2005).

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Considerations about the Client

• Each client is an individual, not a stereotype
• - Be careful about what you think you know about
  a person
• given their cultural background.
• Be aware of the social experiences the client may
  have due to his/her cultural background
• - Society often places certain stigmas on people
  of differing
• cultures. It is important to recognize the
  impact that
• experiences of prejudice/discrimination may
  have on the
• client.

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Considerations about the Relationship

• Recognize that culture is there
• - Cultural differences between the therapist and
  the client can and do influence the relationship
  however, these influences do not have to be
  negative.
• - Differences can be used as a catalyst for
  important and beneficial discussions regarding
  the clients cultural experiences. They can
  educate both members of the relationship and
  breakdown stereotypes.

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Considerations about the Relationship

• Address necessary cultural content
• - If the clients cultural background is
  salient, then it should
• not be ignored.
• Use culture in developing treatment
• - There may be strengths in the clients
  cultural orientation that
• the client and therapist can use.
• - Alternatively, engaging others who are
  relevant to the persons culture can enhance
  treatment (e.g. indigenous healers, church
  leaders, etc.).

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Ok, can we consider an example?

• Earlier in the course we saw Gina an African
  American woman interact with two White male
  therapists.
• - Would the therapists have been more effective
  in this particular case if they had paid more
  attention to Ginas cultural identity and
  background?
• - If so, what might they do to display
  appropriate cultural competence?